Elderly blacks' health care found worse than that of older whites

National study compared members of 2 groups with similar incomes, coverage

March 13, 2002|By Tom Pelton | Tom Pelton,SUN STAFF

Elderly African-Americans receive worse health care than older whites with the same health insurance and comparable incomes, according to a national study being published today.

The study by Dr. Eric C. Schneider of the Harvard School of Public Health concludes that blacks enrolled in Medicare managed-care plans are 21 percent less likely than whites to receive follow-up help after hospitalizations for mental illnesses.

African-Americans over 65 are also 10 percent less likely to receive medications called beta blockers to prevent repeat heart attacks, according to an article in today's Journal of the American Medical Association by Schneider and two Harvard colleagues. Blacks are also 7 percent less likely to get eye exams to prevent blindness from glaucoma resulting from diabetes,

Several factors are generally associated with inferior medical care, including patients with lower income and less education. But the researchers said that even after they corrected for these factors, significant disparities persisted.

"If we said, `This is just racism, it's just part of the American system,' then there would be no potential for change," said Schneider. "We need to intervene and focus on specific areas to improve care to eliminate the disparities."

Experts say the study is significant because it used a huge sample - records from 305,574 Medicare beneficiaries nationally - and compared people of different races with the same insurance policies.

In the past, skeptics have tried to explain the inferior health care and shorter life expectancies of many African-Americans as a product of a lack of health insurance and lower income.

Kweisi Mfume, president of the National Association for the Advancement of Colored People, said he hopes today's report sets off alarms about the need to close the gap in the quality of care.

Inferior medical care compounds the problem blacks have with higher rates of chronic diseases such as hypertension and diabetes, Mfume said. "To tackle the problem, we need to have real public education take place so that people understand themselves and their health conditions in a better way," he said. "We also need better preventive care."

The study compared data submitted in 1997 to the federal government by private health care plans about the kinds of services provided to patients over 65.

The research found that a racial disparity in breast-cancer screening rates could be explained by blacks' disproportionate enrollment in private health plans reimbursed by Medicaid that are worse than plans used largely by whites

But the gaps between whites and blacks in mental health care, glaucoma examinations and heart medications persisted even among people within the same HMOs, according to the study.

"All health plans should attend to racial disparities in care," Schneider wrote with his colleagues, Drs. Alan M. Zaslavsky and Arnold M. Epstein.

"For all too long, we have pretended that once people put the white [doctors'] jackets on, we are impervious to discrimination," said Thomas Perez, a former federal health official who is director of clinical law at the University of Maryland Baltimore. "This study is important because there are still people who believe that discrimination does not play a role in health care."

Susan Pisano, spokeswoman for the American Association of Health Plans, said that the authors of the article don't give enough information to conclude that racism explains the disparities.

"We know that there is an issue with disparities in care, but we don't know why it occurs," said Pisano.

Dr. Leiyu Shi, professor of health policy at the Johns Hopkins School of Public Health, said that although previous studies have shown racial disparities in health care, this one is important because it compares people with the same insurance.

Dr. Claudia Baquet, associate dean for policy at the University of Maryland medical school, said that inferior medical treatment for minorities could help explain why blacks have higher rates of blindness from glaucoma and higher rates of fatality from breast cancer, among other problems.

Baltimore Health Commissioner Dr. Peter Beilenson said the study suggests that, even if states such as Maryland created a universal health care program that gave everyone insurance, a gap in care might persist between blacks and whites. "Although universal health care would certainly help, there are other issues, perhaps related to attitudes by both health care providers and patients that would also have to be addressed."

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